at the great risk that some best practices never get standardized. in my own field, pancreas auto transplant where we take a pancreas out of somebody, treat the cells and give the cells back to the patient. we need a laboratory to treat the cells. medicare at one point paid a bonus of 20,000-dollar payment to hospitals for doing this on top of what they were already charging. it became a very profitable business. we have a laboratory at johns hopkins in the operating room and we have the patient asleep under anesthesia, take a pancreas have intrigued the cells and give the cells back right then and there, same operation. hospitals across the country started doing this operation, taking the pancreas out but because they don't have a laboratory, put it into a cooler and send it by jet to another city, have it treated at another facility in another city or state, have it flown back and then cut the patient open up again for second operation.